A three-year experience of the Referral Center for Surgical Treatment of Gastroesophageal Reflux Disease.

AIM: Gastro-esophageal reflux disease (GERD) rapresents the fastest growing disease affecting the alimentary and breathing apparatus. Incidence of esophageal adenocarcinoma with Barrett Esophagus (BE) imposes a decision about therapy management. METHODS: Between January 2006 to December 2009, 3 653 patients were subjected to our observation; 2 095 patients underwent endoscopy (57.4%), of these 598 underwent twenty-four hours pH-Metry (16.3%); 1 558 patients (42.6%) had clinical consult. RESULTS: A total of 1 255/2 095 referred typical symptoms (60%), 644 patients typical and atypical symptoms (30.7%), 96 patients atypical symptoms (4.6%); 4.7% had dysfagia and cramps; 1 897 patients (90.5%) had Los Angeles A esophagitis, 62 Los Angeles B (2.96%), 6 had Shatzki Ring (0.3%). NERD in 26 patients (1.24%); 3.4% had Hp Gastritis; 33 had BE (1.6%), 10 intestinalized type (30.3%), 23 gatric type (69.7%). Eighty-five/2 095 patients (4%, 36 M and 49 F, m.a. 42.5 years, range 20-72) underwent laparoscopic Nissen-Rossetti Fundoplication (4%), 69 with preoperative typical symptoms (81%), 11 typical and atypical symptoms (13%), 5 atypical symptoms (6%). Twenty-three had BE (27%, 9 intestinal metaplasia, 3 Long and 6 Short Barrett, 14 Gastric metaplasia); 61 with Los Angeles A esophagitis (98.3%), 1 with Shatzki Ring (1.7%). PH-Metries were positive. CONCLUSION: GERD requires specialistic and qualified centers.

Barrett's esophagus after laparoscopic Nissen-Rossetti fundoplication: functional evaluation.

AIM: The aim of this study was to demonstrate the efficacy of laparoscopic antireflux surgery in controlling Barrett's esophagus progression, through functional study. METHODS: Between January 2008 and December 2009, 21 patients with a preoperative diagnosis of Barrett's esophagus underwent Nissen-Rossetti fundoplication. RESULTS: All patients underwent preoperatively a 24-hour pH-metry (100%). Twenty patients (95.2%) had postoperative pH monitoring at six months, 16 patients at 12 months (76.2%), eight at 24 months (57.14%). Median De Meester and Johnson score was preoperatively 18.55 (range 8.6-179.7), at six months 7.65 (range 6.4-13), at 12 months 7.5 (range 6.4-14.2), at 24 months 11.95 (range 6.4-20.6). CLE was still present in 18 patients (18/21, 85.7%), but no patient developed dysplasia or esophageal adenocarcinoma. Two patients with gastric- and one patient with intestinal metaplasia showed complete regression at 12 and 24 months after fundoplication (3/21, 14.3%). Symptom control alone does not manage acid reflux in patients with Barrett's esophagus after surgery, and postoperative 24-hour pH-metry confirms acid reflux abolition. A persistent reflux is more likely to develop cancer than in monitored patients. CONCLUSION: Only the presence of intact and effective anti-reflux wrap guarantees protection of the esophagus against CLE progression or its regression. Functional study after surgery identifies patients with Barrett's progression risk.